Keratoscope-guided opening of graft-host junction to treat elevated astigmatism after deep anterior lamellar keratoplasty

IF 3.7 2区 医学 Q1 OPHTHALMOLOGY
Costanza Rossi, Andrea Lucisano, Giovanni Scalia, Sabrina Vaccaro, Giuseppe Alessio, Andrea Taloni, Maria Angela Romeo, Simone Porchia, Massimiliano Borselli, Adriano Carnevali, Vincenzo Scorcia, Giovanna Carnovale-Scalzo
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Abstract

Aims To describe a simple surgical technique consisting of opening the vertical graft-host junction (GHJ) to manage high astigmatism following deep anterior lamellar keratoplasty (DALK) and to report postoperative visual and topographic outcomes. Methods This is a retrospective interventional case series. Patients affected by high astigmatism after DALK underwent progressive opening of the previous GHJ at the steep meridians, established with preoperative topography and intraoperative keratoscopic guidance. Evaluations were carried out with best corrected visual acuity (BCVA), refractive astigmatism (RA) and keratometric astigmatism (KA) measured with Casia (Tomey, Japan). Visits were conducted preoperatively (T0), 1 week (T1), 6 months (T2) and 1 year after surgery (T3). The Alpins Method was used to evaluate vectorial changes in KA between T0 and T3. Results Fifteen patients were included in the analysis. BCVA (median (IQR)) increased significantly from 0.70 (0.5–1.1) at T0 to 0.20 (0.1–0.3) logMAR at T3 (p=0.001). RA (mean±SD) at T3 was 2.28±1.59 dioptres (D). KA (mean±SD) varied significantly from 8.04±2.14 D at T0 versus 2.93±1.94 D at T1 versus 3.15±1.79 D at T2, versus 3.23±1.63 D at T3 (p<0.0001). Vectorial analysis showed that target induced astigmatism (mean±SD) was 8.04±2.14 D, while surgically induced astigmatism (mean±SD) was 7.89±4.27 D. Correction index (mean±SD) was 0.92±0.33. Conclusions High astigmatism after DALK can be safely and effectively managed by opening the GHJ down to the cleavage plane achieved with the previous surgery, providing low KA and RA, with an overall low tendency to overcorrection. Data are available upon reasonable request. For data requests contact: vscorcia@unicz.it.
角膜镜引导下移植物-宿主连接处开放治疗深前板层角膜移植术后散光加剧
目的介绍一种简单的手术技术,包括打开垂直移植物-主体连接处(GHJ)来治疗深前板层角膜移植术(DALK)后的高度散光,并报告术后视力和地形结果。方法回顾性分析介入治疗病例。在术前地形和术中角膜镜指导下,DALK术后高度散光的患者在陡峭经络处逐步开放前GHJ。采用Casia (Tomey, Japan)测量的最佳矫正视力(BCVA)、屈光散光(RA)和角膜屈光散光(KA)进行评价。术前(T0)、术后1周(T1)、术后6个月(T2)、术后1年(T3)随访。采用Alpins法评价T0至T3 KA的矢量变化。结果15例患者纳入分析。BCVA(中位(IQR))从T0时的0.70(0.5-1.1)显著增加到T3时的0.20 (0.1-0.3)logMAR (p=0.001)。T3时RA (mean±SD)为2.28±1.59 diopres (D)。KA (mean±SD)差异显著,T0时为8.04±2.14 D, T1时为2.93±1.94 D, T2时为3.15±1.79 D, T3时为3.23±1.63 D (p<0.0001)。向量分析结果显示,靶致散光(平均±SD)为8.04±2.14 D,手术致散光(平均±SD)为7.89±4.27 D,校正指数(平均±SD)为0.92±0.33。结论通过将GHJ开放至既往手术达到的劈裂平面,降低KA和RA,整体降低过矫倾向,可以安全有效地控制DALK术后的高度散光。如有合理要求,可提供资料。数据请求请联系:vscorcia@unicz.it。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
10.30
自引率
2.40%
发文量
213
审稿时长
3-6 weeks
期刊介绍: The British Journal of Ophthalmology (BJO) is an international peer-reviewed journal for ophthalmologists and visual science specialists. BJO publishes clinical investigations, clinical observations, and clinically relevant laboratory investigations related to ophthalmology. It also provides major reviews and also publishes manuscripts covering regional issues in a global context.
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